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Urine Culture, Bacterial Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM) 190.12 - Urine Culture, Bacterial Other Names/Abbreviations Urine culture Description A bacterial urine culture is a laboratory test service performed on a urine specimen to establish the probable etiology of a presumed urinary tract infection. It is common practice to do a urinalysis prior to a urine culture. A urine culture for bacteria might also be used as part of the evaluation and management of another related condition. The procedure includes aerobic agar-based isolation of bacteria or other cultivable organisms present, and quantitation of types present based on morphologic criteria. Isolates deemed significant may be subjected to additional identification and susceptibility procedures as requested by the ordering physician. The physician’s request may be through clearly documented and communicated laboratory protocols. HCPCS Codes (Alphanumeric, CPT AMA) Code Description 87086 Culture, bacterial; quantitative, colony count, urine. Culture, bacterial; with isolation and presumptive identification of each 87088 isolates, urine. ICD-10-CM Codes Covered by Medicare Program The ICD-10-CM codes in the table below can be viewed on CMS’ website as part of Downloads: Lab Code List, at http://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html Code Description A02.1 Salmonella sepsis A18.14 Tuberculosis of prostate A34 Obstetrical tetanus A40.0 Sepsis due to streptococcus, group A A40.1 Sepsis due to streptococcus, group B A40.3 Sepsis due to Streptococcus pneumoniae A40.8 Other streptococcal sepsis A40.9 Streptococcal sepsis, unspecified A41.01 Sepsis due to Methicillin susceptible Staphylococcus aureus A41.02 Sepsis due to Methicillin resistant Staphylococcus aureus A41.1 Sepsis due to other specified staphylococcus NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 15 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM) Code Description A41.2 Sepsis due to unspecified staphylococcus A41.3 Sepsis due to Hemophilus influenzae A41.4 Sepsis due to anaerobes A41.50 Gram-negative sepsis, unspecified A41.51 Sepsis due to Escherichia coli [E. coli] A41.52 Sepsis due to Pseudomonas A41.53 Sepsis due to Serratia A41.59 Other Gram-negative sepsis A41.81 Sepsis due to Enterococcus A41.89 Other specified sepsis A41.9 Sepsis, unspecified organism A42.7 Actinomycotic sepsis A56.01 Chlamydial cystitis and urethritis A56.02 Chlamydial vulvovaginitis A56.11 Chlamydial female pelvic inflammatory disease D65 Disseminated intravascular coagulation [defibrination syndrome] D70.0 Congenital agranulocytosis D70.1 Agranulocytosis secondary to cancer chemotherapy D70.2 Other drug-induced agranulocytosis D70.3 Neutropenia due to infection D70.4 Cyclic neutropenia D70.8 Other neutropenia D70.9 Neutropenia, unspecified D72.89 Other specified disorders of white blood cells E09.21 Drug or chemical induced diabetes mellitus with diabetic nephropathy E09.22 Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease E09.29 Drug or chemical induced diabetes mellitus with other diabetic kidney complication E11.10 Type 2 diabetes mellitus with ketoacidosis without coma E11.11 Type 2 diabetes mellitus with ketoacidosis with coma E87.2 Acidosis E87.4 Mixed disorder of acid-base balance F45.8 Other somatoform disorders G93.3 Postviral fatigue syndrome I50.814 Right heart failure due to left heart failure NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 16 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM) Code Description I50.82 Biventricular heart failure I50.84 End stage heart failure I50.89 Other heart failure J80 Acute respiratory distress syndrome K72.00 Acute and subacute hepatic failure without coma K72.01 Acute and subacute hepatic failure with coma K76.2 Central hemorrhagic necrosis of liver M04.1 Periodic fever syndromes M32.14 Glomerular disease in systemic lupus erythematosus M32.15 Tubulo-interstitial nephropathy in systemic lupus erythematosus M35.04 Sicca syndrome with tubulo-interstitial nephropathy M54.89 Other dorsalgia M54.9 Dorsalgia, unspecified N00.0 Acute nephritic syndrome with minor glomerular abnormality N00.1 Acute nephritic syndrome with focal and segmental glomerular lesions N00.2 Acute nephritic syndrome with diffuse membranous glomerulonephritis N00.3 Acute nephritic syndrome with diffuse mesangial proliferative glomerulonephritis N00.4 Acute nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis N00.5 Acute nephritic syndrome with diffuse mesangiocapillary glomerulonephritis N00.6 Acute nephritic syndrome with dense deposit disease N00.7 Acute nephritic syndrome with diffuse crescentic glomerulonephritis N00.8 Acute nephritic syndrome with other morphologic changes N00.9 Acute nephritic syndrome with unspecified morphologic changes N01.0 Rapidly progressive nephritic syndrome with minor glomerular abnormality N01.1 Rapidly progressive nephritic syndrome with focal and segmental glomerular lesions N01.2 Rapidly progressive nephritic syndrome with diffuse membranous glomerulonephritis N01.3 Rapidly progressive nephritic syndrome with diffuse mesangial proliferative glomerulonephritis N01.4 Rapidly progressive nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis N01.5 Rapidly progressive nephritic syndrome with diffuse mesangiocapillary glomerulonephritis N01.6 Rapidly progressive nephritic syndrome with dense deposit disease N01.7 Rapidly progressive nephritic syndrome with diffuse crescentic glomerulonephritis N01.8 Rapidly progressive nephritic syndrome with other morphologic changes NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 17 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM) Code Description N01.9 Rapidly progressive nephritic syndrome with unspecified morphologic changes N05.0 Unspecified nephritic syndrome with minor glomerular abnormality N05.1 Unspecified nephritic syndrome with focal and segmental glomerular lesions N05.2 Unspecified nephritic syndrome with diffuse membranous glomerulonephritis N05.3 Unspecified nephritic syndrome with diffuse mesangial proliferative glomerulonephritis N05.4 Unspecified nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis N05.5 Unspecified nephritic syndrome with diffuse mesangiocapillary glomerulonephritis N05.6 Unspecified nephritic syndrome with dense deposit disease N05.7 Unspecified nephritic syndrome with diffuse crescentic glomerulonephritis N05.8 Unspecified nephritic syndrome with other morphologic changes N05.9 Unspecified nephritic syndrome with unspecified morphologic changes N06.0 Isolated proteinuria with minor glomerular abnormality N06.1 Isolated proteinuria with focal and segmental glomerular lesions N06.2 Isolated proteinuria with diffuse membranous glomerulonephritis N06.3 Isolated proteinuria with diffuse mesangial proliferative glomerulonephritis N06.4 Isolated proteinuria with diffuse endocapillary proliferative glomerulonephritis N06.5 Isolated proteinuria with diffuse mesangiocapillary glomerulonephritis N06.6 Isolated proteinuria with dense deposit disease N06.7 Isolated proteinuria with diffuse crescentic glomerulonephritis N06.8 Isolated proteinuria with other morphologic lesion N06.9 Isolated proteinuria with unspecified morphologic lesion N07.0 Hereditary nephropathy, not elsewhere classified with minor glomerular abnormality N07.1 Hereditary nephropathy, not elsewhere classified with focal and segmental glomerular lesions N07.2 Hereditary nephropathy, not elsewhere classified with diffuse membranous glomerulonephritis N07.3 Hereditary nephropathy, not elsewhere classified with diffuse mesangial proliferative glomerulonephritis N07.4 Hereditary nephropathy, not elsewhere classified with diffuse endocapillary proliferative glomerulonephritis N07.5 Hereditary nephropathy, not elsewhere classified with diffuse mesangiocapillary glomerulonephritis N07.6 Hereditary nephropathy, not elsewhere classified with dense deposit disease N07.7 Hereditary nephropathy, not elsewhere classified with diffuse crescentic glomerulonephritis N07.8 Hereditary nephropathy, not elsewhere classified with other morphologic lesions NCD 190.12 *January 2019 Changes ICD-10-CM Version – Red Fu Associates, Ltd. January 2019 18 Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-10-CM) Code Description N07.9 Hereditary nephropathy, not elsewhere classified with unspecified morphologic lesions N08 Glomerular disorders in diseases classified elsewhere N10 Acute pyelonephritis N11.0 Nonobstructive reflux-associated chronic pyelonephritis N11.1 Chronic obstructive pyelonephritis N11.8 Other chronic tubulo-interstitial nephritis N11.9 Chronic tubulo-interstitial nephritis, unspecified N12 Tubulo-interstitial nephritis, not specified as acute or chronic N13.0 Hydronephrosis with ureteropelvic junction obstruction N13.1 Hydronephrosis with ureteral stricture, not elsewhere classified N13.2 Hydronephrosis with renal and ureteral calculous obstruction N13.4 Hydroureter N13.5 Crossing vessel and stricture of ureter without hydronephrosis N13.6 Pyonephrosis N13.70 Vesicoureteral-reflux, unspecified N13.71 Vesicoureteral-reflux without reflux nephropathy N13.721 Vesicoureteral-reflux with
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